Performance based payment system and the efficiency of hospitals in Turkey
Presenter: Seher Nur Sulku, Turkish Ministry of Health
Background and Objective: In order to align its health care system with the health regulations of the European Union and OECD countries, Turkey has initiated the “Health Transformation Programme” (HTP) in 2003. The health system prior to HTP reforms was fragmented in terms of provision and financing. Health insurance was provided by five separate public schemes each with its own provider network and varying benefit packages. Health care delivery system of Turkey was composed of public and private providers. Within the hospital sector, there were three main public providers: the MoH, the Social Insurance Organization (SSK) and universities (there were 654 hospital operated by the MoH, 120 hospitals operated by the SSK, 50 university hospitals and 270 private hospitals in 2002).
During 2003-2008, Turkey has implemented major health care reforms in order to improve the effciency of its health care system. As part of the major structural changes in the health care system, which includes the integration of security schemes under Social Security Institution (SSI) and the implementation of Universal Health Insurance (UHI), the MoH has implemented important reforms in the financing of the hospital sector. The SSK health facilities have been transferred to the MoH thereby separating the purchaser and the provider of health services. Performance based supplementary payment system has been initiated in the MoH health facilities giving hospitals more autonomy over the use of hospital revenues. Health information systems have been improved.
The objective of our study is to investigate the impact of the performance based payment system implemented as part of the health care reform on the efficiency and productivity of hospitals in Turkey. During the reform period, the dynamic of the hospital sector has been changing due to a rapid increase in the number of private hospitals. The number of private hospitals increased 35 percent from 2002 to 2007. SSI has been contracting with private facilities for the delivery of outpatient and inpatient health services. Currently, around 350 private hospitals have contracts with SSI. But still the MoH hospitals account for 64.4% of the acute care hospitals in Turkey and measuring the impact of the performance based payment system on hospital efficiency is crucial for policymakers to evaluate the health care reforms. Specifically, we test the relationship between (1) hospital operating margins and the number and casemix of patients treated (e.g, in terms of the difficulty of surgeries performed), and (2) performance based payment levels and the number and casemix of patients treated.
Data: We use the 2007 hospital data collected by the MoH which includes hospital characteristics such as number of beds, number of primary care physicians, and number of specialists as well as information on patient services and outputs such as number of inpatient discharges, outpatient visits, and number of surgical operations.
Methodology: Data envelopment approach (DEA) as well as other econometric methods used to measure efficiencies.
Authors: Seher Nur Sulku, Didem Minbay Bernard
Room: No.3 Hall